| NPI | 1831922830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23561) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP053835T) |
| Enumeration Date | 2024-08-23 |
| Last Update Date | 2026-05-28 |