| NPI | 1134736911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PR 4580) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PR 4380) |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2023-07-24 |