| NPI | 1225583826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20556) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA CP032066T) |
| 225100000X Physical Therapist (Licence: AK 231696) | |
| 225100000X Physical Therapist (Licence: PA PT025522) | |
| 225100000X Physical Therapist (Licence: SC CP039007T) | |
| 225100000X Physical Therapist (Licence: OR CP032094T) | |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2025-10-10 |