| NPI | 1962189209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 11927) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P22264) |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2023-07-28 |