| NPI | 1700569696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29955) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 031371) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2024-06-12 |