| NPI | 1205301280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP056429T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 16727) |
| 225100000X Physical Therapist (Licence: CA 298552) | |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2026-06-02 |