| NPI | 1376992297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 130679) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE CP042791T) |
| 225100000X Physical Therapist (Licence: AZ 12277) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2025-03-17 |