| NPI | 1417352865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 10324R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH7259) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2026-01-30 |