| NPI | 1811877145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.029400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 17623-24) |
| 225100000X Physical Therapist (Licence: VA 2305217875) | |
| Enumeration Date | 2025-09-05 |
| Last Update Date | 2026-07-28 |