| NPI | 1659049310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist | |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2025-05-01 |