| NPI | 1043865215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19064) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM P19064) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2025-09-18 |