| NPI | 1710629365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP051817T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214945) |
| 225100000X Physical Therapist (Licence: SC CP026013T) | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2025-12-30 |