| NPI | 1093589624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 307873) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61662714) |
| 225100000X Physical Therapist (Licence: FL 40974) | |
| 225100000X Physical Therapist (Licence: GA PT016993) | |
| 225100000X Physical Therapist (Licence: MI 5501303471) | |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2025-11-17 |