| NPI | 1184183485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18566) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212651) |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2024-01-04 |