| NPI | 1073114963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020507) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046080) |
| 225100000X Physical Therapist (Licence: GA PT017567) | |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2025-04-30 |