| NPI | 1063665958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P11845) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10767) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2026-02-26 |