| NPI | 1134760440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 14732) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 9662) |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2024-12-26 |