| NPI | 1134715485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215905) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046802) |
| 225100000X Physical Therapist (Licence: PA PT031252) | |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2025-08-08 |