| NPI | 1164176459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22020) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030215) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2024-05-13 |