| NPI | 1750195830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP044413T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 12729) |
| 225100000X Physical Therapist (Licence: VA CP04224OT) | |
| Enumeration Date | 2025-02-06 |
| Last Update Date | 2025-05-28 |