| NPI | 1255590741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 009533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 6079) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2026-03-26 |