| NPI | 1427891332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PR 4676) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 65337) |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2025-10-31 |