| NPI | 1386420347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP039652T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP032249T) |
| 225100000X Physical Therapist (Licence: MO 2023048267) | |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2025-02-05 |