| NPI | 1831760131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17312) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: FL PT37078) | |
| 225100000X Physical Therapist (Licence: SC 10972) | |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2022-06-02 |