| NPI | 1528884871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 009316) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT032879) |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2025-05-12 |