| NPI | 1831819259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2023044157) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 5166) |
| 225100000X Physical Therapist (Licence: CA PT307457) | |
| 225100000X Physical Therapist (Licence: CO CP052543T) | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2026-01-30 |