| NPI | 1689396640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 11552) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P21714) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2022-11-04 |