| NPI | 1073089546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019001117) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3888) |
| 225100000X Physical Therapist (Licence: IA 093145) | |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2022-08-17 |