| NPI | 1477324762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11688) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 2-1320) |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2024-01-31 |