| NPI | 1760300578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305217841) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 15414) |
| Enumeration Date | 2026-07-08 |
| Last Update Date | 2026-07-16 |