| NPI | 1467805242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP044623T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-4643) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2025-09-24 |