| NPI | 1891550240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2024005927) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 70.02929) |
| Enumeration Date | 2024-02-15 |
| Last Update Date | 2025-08-07 |