| NPI | 1134775588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH9524) |
| 225100000X Physical Therapist (Licence: MA 25344) | |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2025-03-10 |