| NPI | 1396286696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26731) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041345) |
| 225100000X Physical Therapist (Licence: VA 2305213345) | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2026-05-29 |