| NPI | 1174254890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29105) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P24448) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2026-03-10 |