| NPI | 1922554658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 091601) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2016027260) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2024-02-21 |