| NPI | 1386109239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 149302) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 6103) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2025-03-20 |