| NPI | 1851066237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23738) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214586) |
| 225100000X Physical Therapist (Licence: NC CP024194T) | |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2024-12-23 |