| NPI | 1730899394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 11660) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0019600) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2026-01-31 |