| 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 |