| NPI | 1477446656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD CP044808T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 132790) |
| Enumeration Date | 2025-05-29 |
| Last Update Date | 2025-05-29 |