| NPI | 1477372373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP048727T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA CP054191T) |
| 225100000X Physical Therapist (Licence: PA PT032817) | |
| Enumeration Date | 2024-10-08 |
| Last Update Date | 2026-08-05 |