| NPI | 1124793880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP026015T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28587) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2023-12-05 |