| NPI | 1124752936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12394) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP049896T) |
| 225100000X Physical Therapist (Licence: WA CP042359T) | |
| 225100000X Physical Therapist (Licence: NC CP055189T) | |
| Enumeration Date | 2022-07-16 |
| Last Update Date | 2026-05-13 |