| NPI | 1225627995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP049426T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 13265) |
| Enumeration Date | 2021-01-15 |
| Last Update Date | 2026-06-01 |