| NPI | 1124544218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-13203) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 13073) |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2024-03-06 |