| NPI | 1760973754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.16507) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211930) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2025-07-25 |