| NPI | 1770448946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 13330) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14.015254) |
| Enumeration Date | 2025-12-19 |
| Last Update Date | 2026-05-07 |