| NPI | 1578374609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23761) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP039677T) |
| Enumeration Date | 2025-01-17 |
| Last Update Date | 2025-01-17 |