| NPI | 1376067694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-9240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-1721) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2024-05-28 |