| NPI | 1912588534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP048646T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02233500) |
| 225100000X Physical Therapist (Licence: NY 047136) | |
| 225100000X Physical Therapist (Licence: VA CP043129T) | |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2025-08-29 |