| NPI | 1740940030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10640) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030437) |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2025-01-14 |