| NPI | 1811635204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022026444) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 8158) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2022-07-11 |