| NPI | 1285153924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2025007113) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12553) |
| 225100000X Physical Therapist (Licence: KS 11-06378) | |
| 225100000X Physical Therapist (Licence: OR 63144) | |
| 225100000X Physical Therapist (Licence: KY 008274) | |
| 225100000X Physical Therapist (Licence: AZ 13206) | |
| 225100000X Physical Therapist (Licence: GA PT013939) | |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2026-04-08 |