| NPI | 1891393419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65027) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36321) |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2023-07-28 |