| NPI | 1255190211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD CPO54684T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040-0134688) |
| Enumeration Date | 2024-03-13 |
| Last Update Date | 2026-05-18 |