| NPI | 1154100436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP046520T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29631) |
| Enumeration Date | 2023-09-26 |
| Last Update Date | 2025-07-08 |