| NPI | 1851616155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P12311) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 7348) |
| 225100000X Physical Therapist (Licence: VA 2305205753) | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2026-04-29 |