| NPI | 1588361687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21994) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11775) |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2023-03-10 |