| NPI | 1649924911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24478) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28846) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2026-04-23 |