| NPI | 1316779374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH12110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 2-1398) |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-11-11 |