| NPI | 1861222788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 009141) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC PT13065) |
| 225100000X Physical Therapist (Licence: ME PT7067) | |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2025-08-29 |