| NPI | 1700648417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216252) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP052206T) |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2026-02-05 |