| NPI | 1033535158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT 003295) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP044192T) |
| 225100000X Physical Therapist (Licence: GA CP059135T) | |
| 225100000X Physical Therapist (Licence: TN 14042) | |
| 225100000X Physical Therapist (Licence: AL CP059103T) | |
| 225100000X Physical Therapist (Licence: PA CP059034T) | |
| Enumeration Date | 2014-03-13 |
| Last Update Date | 2026-07-07 |