| NPI | 1720315500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 011330) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206202) |
| Enumeration Date | 2009-11-16 |
| Last Update Date | 2025-12-09 |