| NPI | 1821723297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-7981) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2022029652) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2022-07-28 |