| NPI | 1952904617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10136) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PTH10136) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2024-09-12 |