| NPI | 1467384487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2026023015) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP058371T) |
| Enumeration Date | 2026-06-02 |
| Last Update Date | 2026-06-04 |