| NPI | 1053810481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17684) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC PT11719) |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2025-07-02 |