| NPI | 1871265413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 61519866) |
| 225100000X Physical Therapist (Licence: IL 070-026254) | |
| 225100000X Physical Therapist (Licence: CA PT305934) | |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2025-07-01 |