| NPI | 1366189334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008611) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TP2022035) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2022-08-09 |