| NPI | 1346735545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8231) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P15802) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2025-10-30 |