| NPI | 1780251371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22806) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10677) |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2025-01-03 |