| NPI | 1760144372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 014044) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 109599) |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2024-03-14 |