| NPI | 1255269502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP055124T) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA CP055124T) |
| Enumeration Date | 2026-05-08 |
| Last Update Date | 2026-05-28 |