| NPI | 1932871035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH12021) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 13841) |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2024-11-05 |