| NPI | 1427783521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 2022032824) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NY 040692-01) | |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2023-11-08 |