| NPI | 1083422521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 11744R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38857) |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2025-03-21 |