| NPI | 1366099046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9545) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AL PTH9545) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2024-10-02 |