| NPI | 1023747730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030590) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215874) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2026-06-19 |