| NPI | 1831922541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216888) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P21565) |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2026-07-29 |