| NPI | 1629651088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20206) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10585) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2021-06-17 |