| NPI | 1780322693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019019252) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38748) |
| 225100000X Physical Therapist (Licence: NC P22812) | |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2026-01-06 |