| NPI | 1922650373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4059) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2021-10-04 |