| NPI | 1740166826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24317) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH CP050610T) |
| 225100000X Physical Therapist (Licence: SC CP048853T) | |
| Enumeration Date | 2025-08-13 |
| Last Update Date | 2026-06-18 |