| NPI | 1063180438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20741) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: MD CP034948T) | |
| 225100000X Physical Therapist (Licence: SC 12056) | |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2025-01-15 |