| NPI | 1275098089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10499) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P18538) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2021-01-13 |