| NPI | 1033891114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP052793T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT031458) |
| 225100000X Physical Therapist (Licence: PA DAPT006538) | |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2026-02-16 |