| NPI | 1558933044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 109237) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16274) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2024-01-30 |