| NPI | 1992474894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22811) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029822) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2024-01-19 |