| NPI | 1386134559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 15668) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CO 0015594) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2023-07-17 |