| NPI | 1356012868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21450) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P21450) |
| 225100000X Physical Therapist (Licence: VA 2305214699) | |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2025-12-10 |