| NPI | 1679203434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64468) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2024-03-06 |