| NPI | 1982398202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12616) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI Pending) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2024-12-06 |