| NPI | 1407575244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC CP049093T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 18632) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2025-09-08 |