| NPI | 1891363677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-7198) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64152) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2021-06-16 |