| NPI | 1154096766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30647) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214541) |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2025-11-05 |