| NPI | 1477875185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 17779) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11665) |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2026-02-20 |