| NPI | 1194369967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29602) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12512) |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2023-09-28 |