| NPI | 1801691704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN CP042206T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P23815) |
| Enumeration Date | 2025-02-14 |
| Last Update Date | 2026-06-16 |