| NPI | 1710726393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 055695) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH CP035178T) |
| 225100000X Physical Therapist (Licence: WV 004771) | |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2026-04-17 |