| NPI | 1851196125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23896) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP060441T) |
| Enumeration Date | 2025-02-19 |
| Last Update Date | 2026-08-05 |