| NPI | 1639908098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC PT13491) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41882) |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2026-07-28 |