| NPI | 1255157541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP051824T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT42926) |
| 225100000X Physical Therapist (Licence: SD 6117) | |
| 225100000X Physical Therapist (Licence: MA PTL89065) | |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2026-02-17 |