| NPI | 1285322230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 6240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0019721) |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2025-05-14 |