| NPI | 1396900080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P11708) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: SC 6458) | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2025-08-25 |