| NPI | 1982184578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043254) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 11700R) |
| 225100000X Physical Therapist (Licence: NC P25082) | |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2026-07-21 |