| NPI | 1497354096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP058830T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PT021426) |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2026-08-31 |