| NPI | 1689116477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10651) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61925) |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2024-07-30 |