| NPI | 1861863318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9428) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 30731) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2024-12-11 |