| NPI | 1962152876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30011) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 14114) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2024-07-04 |