| NPI | 1770229973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI CP042499T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P21255) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2025-03-04 |