| NPI | 1255876249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16846) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P17710) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2026-03-30 |