| NPI | 1982274031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4236) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA CP025864T) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2023-11-02 |