| NPI | 1588157515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 17112) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: OR 62694) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2025-08-04 |