| NPI | 1891281465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP043681T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10320) |
| 225100000X Physical Therapist (Licence: VA CP042382T) | |
| Enumeration Date | 2018-07-07 |
| Last Update Date | 2025-04-16 |