| NPI | 1962942425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA CP022069T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT30764) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2017-03-03 |
| Last Update Date | 2023-07-13 |