| NPI | 1255664223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21795) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD PT21795) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2025-09-23 |