| NPI | 1134849136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 009342) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 4393) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2025-08-11 |