| NPI | 1992398358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24566) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214177) |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2025-12-29 |