| NPI | 1003648635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 307463) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT6924) |
| 225100000X Physical Therapist (Licence: AZ LPT-033842) | |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2025-12-29 |