| NPI | 1528843687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CPO53447T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD CP049435T) |
| 225100000X Physical Therapist (Licence: GA CP043034T) | |
| 225100000X Physical Therapist (Licence: VA 2305216055) | |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2026-02-20 |