| NPI | 1720670706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16080-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028865) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2025-02-17 |