| NPI | 1427302181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3917) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207731) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2025-11-17 |