| NPI | 1366180929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23038) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-32360) |
| 225100000X Physical Therapist (Licence: NC CP026373T) | |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2024-03-06 |