| NPI | 1215657523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP049812T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT42722) |
| 225100000X Physical Therapist (Licence: VA 2305215378) | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2025-09-30 |