| NPI | 1770450124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP050485T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305217444) |
| Enumeration Date | 2025-10-21 |
| Last Update Date | 2025-11-03 |