| NPI | 1427644566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10524) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NC P20933) | |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2022-10-20 |