| NPI | 1497227961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9312) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 1-0969) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2021-08-31 |