| NPI | 1871485136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 17382-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA CP046740T) |
| Enumeration Date | 2025-07-19 |
| Last Update Date | 2025-10-30 |