| NPI | 1043995525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP025674T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 5160) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-10-18 |