| NPI | 1689211716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19839) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10023) |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2026-02-02 |