| NPI | 1134802507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12392) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 11622) |
| 225100000X Physical Therapist (Licence: PA PT032043) | |
| 225100000X Physical Therapist (Licence: OR 65121) | |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2024-08-12 |