| NPI | 1790548873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CPO59314T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP038584T) |
| 225100000X Physical Therapist (Licence: NJ 40QA02238300) | |
| Enumeration Date | 2024-02-01 |
| Last Update Date | 2026-07-21 |