| NPI | 1154917813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP032698T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: SC 10468) | |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2024-11-05 |