| NPI | 1821728072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2023008583) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06999) |
| Enumeration Date | 2022-06-12 |
| Last Update Date | 2026-04-21 |