| NPI | 1710763818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH12037) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT031571) |
| 225100000X Physical Therapist (Licence: MD 30027) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-09-05 |
| Last Update Date | 2024-11-01 |