| NPI | 1952085144 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12957) | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP042126T) | 
| 225100000X Physical Therapist (Licence: GA PT016568) | |
| Enumeration Date | 2023-06-09 | 
| Last Update Date | 2025-09-08 |