| NPI | 1114495850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 11442R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH9205) |
| Enumeration Date | 2018-11-12 |
| Last Update Date | 2023-03-22 |