| NPI | 1720653256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 10583) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH10286) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2026-04-08 |