| NPI | 1144791922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2023024481) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IL 160.007966) |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2023-12-12 |