| NPI | 1063103273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP057810T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT031256) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2026-08-03 |