| NPI | 1952088445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11616) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 2-1234) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2023-11-09 |