| NPI | 1003236308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7917) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023267) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2025-07-25 |