| NPI | 1710751862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 014236) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 012385) |
| Enumeration Date | 2023-11-09 |
| Last Update Date | 2025-12-18 |