| NPI | 1114685955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP029940T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA cp021636T) |
| 225100000X Physical Therapist (Licence: IA 108586) | |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2024-03-18 |