| NPI | 1982385852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD T17311) |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2023-11-15 |