| NPI | 1508323817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PT009209L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT009209L) |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2021-03-17 |