| NPI | 1467060418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 26619) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP011852T) |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: TN 12902) | |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2023-01-23 |