| NPI | 1184382509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP055033T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC PT004716) |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2026-05-24 |