| NPI | 1144119090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP048708T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT017906) |
| Enumeration Date | 2025-07-02 |
| Last Update Date | 2025-08-18 |