| NPI | 1295301299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2021022662) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2022-08-12 |