| NPI | 1386370823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH10936) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2024-10-28 |