| NPI | 1306523428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22361) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11885) |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2025-03-05 |