| NPI | 1760112791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO CP022508T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 4356) |
| 225100000X Physical Therapist (Licence: NJ CP030640T) | |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-01-13 |