| NPI | 1619536083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9512) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 14304) |
| 225100000X Physical Therapist (Licence: VA CP052211T) | |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2026-01-23 |