| NPI | 1932892726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24809) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215658) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2026-05-07 |