| NPI | 1912523911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7850) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 09675) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2025-08-05 |