| NPI | 1013562370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2021015010) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P19074) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2025-08-13 |