| NPI | 1093338428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 175662) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 15038-24) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2022-08-30 |