| NPI | 1689539843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP051706T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT016609) |
| Enumeration Date | 2025-12-19 |
| Last Update Date | 2025-12-23 |