| NPI | 1407144397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216890) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P21912) |
| 225100000X Physical Therapist (Licence: IL 070018542) | |
| 225100000X Physical Therapist (Licence: TN 15522) | |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2025-03-30 |