| NPI | 1295455749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12326) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 14439) |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2024-05-22 |