| NPI | 1982412995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI CP045050T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 118496) |
| Enumeration Date | 2024-12-23 |
| Last Update Date | 2025-07-24 |