| NPI | 1336070291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP058106T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 12347) |
| Enumeration Date | 2026-05-28 |
| Last Update Date | 2026-05-28 |