| NPI | 1053542126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30468) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P14525) |
| 225100000X Physical Therapist (Licence: WI 11294024) | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2026-07-05 |