| NPI | 1942686621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21680) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21937) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2022-10-03 |