| NPI | 1952954935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P-CP011461T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2022-05-20 |