| NPI | 1932973583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23997) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 051499) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2026-04-21 |