| NPI | 1902423700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213736) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO CP052767T) |
| 225100000X Physical Therapist (Licence: MD 30225) | |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2026-01-22 |