| NPI | 1356073126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10950) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 2-1125) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2022-08-04 |