| NPI | 1699548859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 11657) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29796) |
| Enumeration Date | 2023-10-31 |
| Last Update Date | 2024-09-13 |