| NPI | 1619537065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11007) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12215) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2022-10-18 |