| NPI | 1730840554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10719) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 2-1088) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2026-01-07 |