| NPI | 1598492928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23334) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38912) |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2024-09-18 |