| NPI | 1861771651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15281) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033895) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2026-03-26 |