| NPI | 1588382709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22816) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT39209) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2024-05-14 |