| NPI | 1942723267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23016) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26521) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2024-08-29 |