| NPI | 1487109294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16620) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025461) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2026-06-03 |