| NPI | 1619350097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7787) |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2023-11-07 |