| NPI | 1689169997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14268-24) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 14268-24) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2025-05-27 |