| NPI | 1326504622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1325979) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60958690) |
| 225100000X Physical Therapist (Licence: GA CP004992T) | |
| 225100000X Physical Therapist (Licence: SC 9526) | |
| 225100000X Physical Therapist (Licence: TN CP003602T) | |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2023-09-12 |