| NPI | 1477183010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AR 4207) |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2024-04-17 |