| NPI | 1053059642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215020) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP026249T) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2026-04-14 |