| NPI | 1265161467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11112) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 2-1133) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2022-11-16 |