| NPI | 1649018334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2024045334) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-07679) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2026-01-15 |