| NPI | 1689356859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24391) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215956) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2025-10-22 |