| NPI | 1730848433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 220774) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 15657-24) |
| Enumeration Date | 2021-12-10 |
| Last Update Date | 2026-01-07 |