| NPI | 1851866453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL pTH9102) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH7162) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2022-03-29 |