| NPI | 1205520756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP051426T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215827) |
| 225100000X Physical Therapist (Licence: SC CP051425T) | |
| 225100000X Physical Therapist (Licence: CO CP056417T) | |
| 225100000X Physical Therapist (Licence: CO PTL.0021355) | |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2026-08-26 |