| NPI | 1770384554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP043017T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT7774) |
| Enumeration Date | 2025-03-19 |
| Last Update Date | 2025-03-28 |