| NPI | 1205506912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28688) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10839) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2022-05-10 |