| NPI | 1427724772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29816) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029746) |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2024-03-23 |