| NPI | 1215587746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4825) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27688) |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2021-08-26 |