| NPI | 1497597215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24314) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29948) |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2025-10-29 |