| NPI | 1861327025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5839) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2023021889) |
| Enumeration Date | 2026-06-17 |
| Last Update Date | 2026-07-28 |