| NPI | 1124819024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12853) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP044490T) |
| Enumeration Date | 2025-05-13 |
| Last Update Date | 2025-08-25 |