| NPI | 1003907502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP024669T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-5794) |
| 225100000X Physical Therapist (Licence: CA 305811) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: UT 285255-2401) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2025-11-13 |