| NPI | 1366320608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP053045T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305217384) |
| 225100000X Physical Therapist (Licence: MN 14116) | |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2026-03-10 |