| NPI | 1649156779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 106437) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: IA 106437) |
| Enumeration Date | 2025-08-13 |
| Last Update Date | 2025-08-13 |