| NPI | 1538943477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 121124) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE CP034980T) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2024-09-19 |