| NPI | 1528037934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP044333T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24066) |
| 225100000X Physical Therapist (Licence: NH 2153) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2025-11-04 |