| NPI | 1154834364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10527) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26779) |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2023-04-20 |