| NPI | 1548998784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12808) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049150) |
| 225100000X Physical Therapist (Licence: TN 16021) | |
| Enumeration Date | 2022-08-14 |
| Last Update Date | 2025-08-21 |