| NPI | 1861377764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5688) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO CP048638T) |
| Enumeration Date | 2025-08-08 |
| Last Update Date | 2025-08-25 |