| NPI | 1659939262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 012441) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12190) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2024-10-20 |