| NPI | 1487378873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215301) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC CP055985T) |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2026-05-06 |