| NPI | 1114606191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22814) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215879) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2025-02-06 |