| NPI | 1205956182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13545) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 002141) |
| 225100000X Physical Therapist (Licence: CA 33469) | |
| 225100000X Physical Therapist (Licence: HI 2603) | |
| 225100000X Physical Therapist (Licence: WA 10377) | |
| 225100000X Physical Therapist (Licence: MD 20388) | |
| 225100000X Physical Therapist (Licence: NV 2092) | |
| 225100000X Physical Therapist (Licence: TX 1169653) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2026-08-25 |