| NPI | 1962121434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 2-1157) |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2022-11-04 |