| NPI | 1376414557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10674) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP049276T) |
| Enumeration Date | 2025-09-12 |
| Last Update Date | 2025-10-08 |