| NPI | 1821447327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21737) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013998) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2025-11-24 |