| NPI | 1922747864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 304200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014540) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2023-09-13 |