| NPI | 1598757841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH5787) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT2390) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2026-03-31 |