| NPI | 1558987933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19929) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12679) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2025-07-24 |