| NPI | 1558716027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 095370) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12274PT) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2023-10-17 |