| NPI | 1487347969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4518) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030294) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2023-08-02 |