| NPI | 1205671427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP031979T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT7773) |
| 225100000X Physical Therapist (Licence: TN CP053295T) | |
| Enumeration Date | 2024-06-28 |
| Last Update Date | 2026-02-10 |