| NPI | 1356869416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14128-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 8594) |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2025-05-15 |