| NPI | 1568001089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19361) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP030888T) |
| Enumeration Date | 2020-01-01 |
| Last Update Date | 2026-07-17 |