| NPI | 1164949475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN CP056457T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7082) |
| 225100000X Physical Therapist (Licence: NC P12525) | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2026-05-13 |