| NPI | 1366255820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12882) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT42825) |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-06-18 |