| NPI | 1912605726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65306) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P21974) |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2024-05-24 |