| NPI | 1831744127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11172) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2025-05-01 |