| NPI | 1780469189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12552PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P22602) |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2025-09-25 |