| NPI | 1912794074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23844) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP046600T) |
| Enumeration Date | 2025-04-22 |
| Last Update Date | 2026-02-05 |