| NPI | 1497314090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 5548) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM Temporary) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2021-02-08 |