| NPI | 1194349381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 7621) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4271) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2021-08-30 |