| NPI | 1346134335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH12639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P24116) |
| Enumeration Date | 2025-06-05 |
| Last Update Date | 2026-04-02 |