| NPI | 1669266904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS 8067) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 12002R) |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2025-08-11 |