| NPI | 1679272413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29326) |
| 225100000X Physical Therapist (Licence: DE CP021791T) | |
| 225100000X Physical Therapist (Licence: CO CP032875T) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2024-11-19 |