| NPI | 1972482693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP051648T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP049120T) |
| 225100000X Physical Therapist (Licence: OH PT022001) | |
| Enumeration Date | 2025-08-27 |
| Last Update Date | 2026-04-22 |