| NPI | 1730887910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21928) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11765) |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2023-02-24 |