| NPI | 1063949394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8413) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8757) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2022-07-21 |