| NPI | 1073907093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017585) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018407) |
| 225100000X Physical Therapist (Licence: NJ 40QA01580400) | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2026-05-13 |