| NPI | 1821684291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 12070728-2401) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2022-03-30 |