| NPI | 1912383159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15876) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT024614) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2022-12-21 |