| NPI | 1306577952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24377) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214978) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2025-10-06 |