| NPI | 1225568611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9337) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8656) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-03-08 |