| NPI | 1558480574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 4259) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 1295024) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2026-03-27 |