| NPI | 1578951695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25355) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP019069T) |
| 225100000X Physical Therapist (Licence: VA CP019074T) | |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2026-01-26 |