| NPI | 1760078315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 11250) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36061) |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2024-11-11 |