| NPI | 1710647144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-LIC-19574) |
| 225100000X Physical Therapist (Licence: OR CP008901T) | |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2021-12-27 |