| NPI | 1972296994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 7957) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64348) |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2023-05-26 |