| NPI | 1245196674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24560) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 055288) |
| Enumeration Date | 2025-12-30 |
| Last Update Date | 2025-12-30 |