| NPI | 1003231879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP022514T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 4334) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2026-04-23 |