| NPI | 1568036838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10365) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 1-1143) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2021-06-02 |