| NPI | 1912781600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC EP1252476) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT43714) |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2026-06-05 |