| NPI | 1336887280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 13707) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14.013487-TEMP) |
| Enumeration Date | 2022-05-21 |
| Last Update Date | 2022-09-02 |