| NPI | 1881499028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12974) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH12185) |
| Enumeration Date | 2025-02-13 |
| Last Update Date | 2025-08-06 |