| NPI | 1578054235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT4559) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2018032819) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2021-11-29 |