| NPI | 1861438038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH4021) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 14501) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2026-07-06 |