| NPI | 1811672363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23925) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0019179) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2025-03-03 |