| NPI | 1427720325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 10930) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2024-08-23 |