| NPI | 1700593365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21652) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11574) |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2022-11-03 |