| NPI | 1780351239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11856) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25667) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2024-10-17 |