| NPI | 1629683362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16323) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216559) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2025-03-20 |