| NPI | 1588204721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20566) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213383) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2021-09-21 |