| NPI | 1043944705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23106) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048698) |
| Enumeration Date | 2022-07-10 |
| Last Update Date | 2025-10-14 |