| NPI | 1023533825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16127-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY CP027048T) |
| 225100000X Physical Therapist (Licence: VA CP027051T) | |
| 225100000X Physical Therapist (Licence: TN CP027050T) | |
| 225100000X Physical Therapist (Licence: SC CP031411T) | |
| 225100000X Physical Therapist (Licence: IL 070.023017) | |
| 225100000X Physical Therapist (Licence: MO CP027049T) | |
| 225100000X Physical Therapist (Licence: NC CP042984T) | |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2025-09-04 |