| NPI | 1225557390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13968-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007209) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2024-02-26 |