| NPI | 1801504030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2024006381) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37572) |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2024-02-17 |