| NPI | 1487490561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11988) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 15739) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2026-04-10 |