| NPI | 1497300735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9674) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027837) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2025-10-06 |