| NPI | 1154823094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT7186) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 10636251-2401) |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2021-02-16 |