| NPI | 1558195917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24412) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61628802) |
| 225100000X Physical Therapist (Licence: NY 052939) | |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2025-08-27 |