| NPI | 1669219739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP039911T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP035262T) |
| 225100000X Physical Therapist (Licence: NC CP032670T) | |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2025-03-07 |