| NPI | 1578276390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16644-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PTT39797) |
| Enumeration Date | 2022-12-27 |
| Last Update Date | 2024-05-23 |