| NPI | 1912656398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21053) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11608) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2022-11-21 |