| NPI | 1053142695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P241142) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 27771) |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2025-06-18 |