| NPI | 1043806672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP061581T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213538) |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2026-09-02 |