| NPI | 1821871187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CPO43386T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 008877) |
| Enumeration Date | 2023-08-18 |
| Last Update Date | 2025-04-10 |