| NPI | 1861226839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12783) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41873) |
| Enumeration Date | 2024-08-30 |
| Last Update Date | 2025-03-20 |