| NPI | 1598256935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 13364) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027043) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2026-07-14 |