| NPI | 1558029652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.025989) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015724) |
| 225100000X Physical Therapist (Licence: OH PT019396) | |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2026-01-05 |