| NPI | 1992371306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2025037636) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT4941) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2025-10-10 |