| NPI | 1750130076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 6063) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE CP031726T) |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2025-09-11 |