| NPI | 1215657986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5463) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 008581) |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2025-07-29 |