| NPI | 1538021902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP051852T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-034546) |
| Enumeration Date | 2025-11-24 |
| Last Update Date | 2026-01-19 |