| NPI | 1548972615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP046346T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 5093) |
| Enumeration Date | 2022-12-20 |
| Last Update Date | 2025-07-23 |