| NPI | 1902282882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7852) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P17456) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2024-04-11 |