| NPI | 1730851841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 37485) |
| 225100000X Physical Therapist (Licence: FL PT37485) | |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2024-01-08 |