| NPI | 1881177210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020434) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014235) |
| 225100000X Physical Therapist (Licence: ME PT5233) | |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2025-04-08 |