| NPI | 1952049033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP048197T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: LA 11211) | |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2026-05-12 |