| NPI | 1881806404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-1730) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT009431) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2025-10-31 |