| NPI | 1265146963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP043916T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP035275T) |
| 225100000X Physical Therapist (Licence: TN 14748) | |
| 225100000X Physical Therapist (Licence: CA 304936) | |
| 225100000X Physical Therapist (Licence: FL PT42664) | |
| 225100000X Physical Therapist (Licence: NC CP0277702T) | |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2025-11-27 |