| NPI | 1386203750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4033) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 11297601-2401) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2021-05-20 |