| NPI | 1114791092 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41063) | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-034056) | 
| 225100000X Physical Therapist (Licence: VA 2305216170) | |
| 225100000X Physical Therapist (Licence: CO PTL.0019776) | |
| Enumeration Date | 2023-11-10 | 
| Last Update Date | 2025-09-27 |