| NPI | 1033818190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214707) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP044024T) |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2026-02-10 |