| NPI | 1578288890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65641) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: GA PT016248) | |
| Enumeration Date | 2022-10-10 |
| Last Update Date | 2025-03-21 |