| NPI | 1184318669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL19060) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4970) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2023-06-07 |