| NPI | 1750875472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 026877) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT026877) |
| Enumeration Date | 2018-06-16 |
| Last Update Date | 2023-01-30 |