| NPI | 1982206736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23620) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36389) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2024-10-03 |