| NPI | 1164032819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH10204) |
| 225100000X Physical Therapist (Licence: MS PT6966) | |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2024-06-05 |