| NPI | 1649957408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23099) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT031434) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2024-10-08 |