| NPI | 1902736994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP056696T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29771) |
| 225100000X Physical Therapist (Licence: AK 220271) | |
| Enumeration Date | 2026-05-21 |
| Last Update Date | 2026-06-25 |