| NPI | 1699542332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11605) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2023-12-04 |