| NPI | 1861109100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2022043936) |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2025-08-05 |