| NPI | 1669088084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002178) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214285) |
| 225100000X Physical Therapist (Licence: NY 046354) | |
| 225100000X Physical Therapist (Licence: MD 28237) | |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2026-06-03 |