| NPI | 1528618535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19063) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28865) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2024-12-05 |