| NPI | 1770545089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12804) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT015649) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2025-07-23 |