| NPI | 1871078386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21138) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212305) |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2025-08-10 |