| NPI | 1265222426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44164) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP044358T) |
| 225100000X Physical Therapist (Licence: WI 16827-24) | |
| Enumeration Date | 2025-05-10 |
| Last Update Date | 2026-01-06 |