| NPI | 1861207342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12811) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT033020) |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-05-09 |