| NPI | 1295346880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK CP051366T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028642) |
| Enumeration Date | 2020-08-16 |
| Last Update Date | 2026-02-09 |