| NPI | 1326853771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30291) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC CP042482T) |
| Enumeration Date | 2025-02-12 |
| Last Update Date | 2025-07-18 |