| NPI | 1982216537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008037) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 13210) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2022-08-04 |