| NPI | 1053168179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034427) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NM PT-2024-0326) | |
| 225100000X Physical Therapist (Licence: WA PT61681248) | |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2025-11-07 |