| NPI | 1831613983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17298) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP052381T) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2026-02-20 |