| NPI | 1336885292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 193669) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030102) |
| 225100000X Physical Therapist (Licence: TN 12873) | |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2022-05-12 |