| NPI | 1689672818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24115) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT001979E) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2025-10-22 |