| NPI | 1407311905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 027587) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 6073) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2024-06-07 |