| NPI | 1811727332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24816) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41890) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2026-04-03 |