| NPI | 1508634577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23891) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 051273) |
| Enumeration Date | 2023-12-19 |
| Last Update Date | 2025-02-18 |