| NPI | 1932726908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23217) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT021499) |
| 225100000X Physical Therapist (Licence: MI 5501019570) | |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2026-06-10 |