| NPI | 1467112680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23990) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048290) |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2025-05-14 |