| NPI | 1821601881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7269) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 10811) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2024-01-05 |