| NPI | 1073278859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 115369) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 15598) |
| Enumeration Date | 2021-11-05 |
| Last Update Date | 2022-11-04 |