| NPI | 1154802569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP060194T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT4478) |
| 225100000X Physical Therapist (Licence: UT 14280812-2401) | |
| 225100000X Physical Therapist (Licence: UT CP053492T) | |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2026-08-27 |