| NPI | 1386535797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 6755) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT018300) |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2026-06-08 |