| NPI | 1902441439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY PT1932) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044522) |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2026-03-05 |