| NPI | 1952085144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP053410T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP042126T) |
| 225100000X Physical Therapist (Licence: SC 12957) | |
| 225100000X Physical Therapist (Licence: GA PT016568) | |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2026-06-08 |