| NPI | 1952087157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH CP027618T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT020464) |
| 225100000X Physical Therapist (Licence: NC P-CP022376T) | |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2024-01-28 |