| NPI | 1962134411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 15829-24) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WI 15829-24) |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2025-11-24 |