| NPI | 1407719735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-035018) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 054917) |
| 225100000X Physical Therapist (Licence: NC P24582) | |
| Enumeration Date | 2025-12-04 |
| Last Update Date | 2026-09-29 |