| NPI | 1780333245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022027510) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2022-10-12 |