| NPI | 1336818301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10621) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 1-1177) |
| Enumeration Date | 2021-09-12 |
| Last Update Date | 2021-11-12 |