| NPI | 1710546734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21626) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27524) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2023-07-11 |