| NPI | 1033422902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8765) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206565) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2025-12-10 |