| NPI | 1336657519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: OR 7248100954) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2024-10-01 |