| NPI | 1548108210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 12273R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT8125) |
| Enumeration Date | 2026-03-24 |
| Last Update Date | 2026-03-24 |