| NPI | 1336977537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23411) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT310218) |
| 225100000X Physical Therapist (Licence: WA PT.PT.70114173) | |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2026-07-14 |