| NPI | 1598171324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT5598) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: AL PTH8824) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2024-05-27 |