| NPI | 1295248649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7826) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH8701) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2024-11-07 |