| NPI | 1578109153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP022892T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME 5520) |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2025-07-23 |