| NPI | 1205594116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 100259) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 111114) |
| Enumeration Date | 2021-12-08 |
| Last Update Date | 2023-02-01 |