| NPI | 1811727332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30135) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41890) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-09-04 |