| NPI | 1144082835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24734) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 051596) |
| 225100000X Physical Therapist (Licence: MA PTL27367) | |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2026-05-11 |