| NPI | 1205481173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12197) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213054) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2024-02-05 |