| NPI | 1326560202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05634) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 088149) |
| 225100000X Physical Therapist (Licence: UT 10414606-2401) | |
| 225100000X Physical Therapist (Licence: CT 11439) | |
| 225100000X Physical Therapist (Licence: NC P17249) | |
| 225100000X Physical Therapist (Licence: MO 2018015454) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2025-06-04 |