| NPI | 1871022889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21840) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0014893) |
| 225100000X Physical Therapist (Licence: SC 11187) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2023-08-16 |