| NPI | 1770101487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH9714) |
| Enumeration Date | 2020-07-09 |
| Last Update Date | 2025-01-03 |