| NPI | 1134774029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP042996T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213034) |
| 225100000X Physical Therapist (Licence: SC 12307) | |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2025-03-19 |