| NPI | 1629661160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP031609T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214143) |
| Enumeration Date | 2021-02-16 |
| Last Update Date | 2024-05-30 |