| NPI | 1740929405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022023555) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 8156) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2022-06-25 |