| NPI | 1154003275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC CP039511T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 305331) |
| 225100000X Physical Therapist (Licence: TX CP029344T) | |
| 225100000X Physical Therapist (Licence: SD 2653) | |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2025-03-10 |