| NPI | 1679039028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10386) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27355) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2021-06-24 |