| NPI | 1538764287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4560) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 19523) |
| 225100000X Physical Therapist (Licence: UT 11788181-2401) | |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2023-09-06 |