| NPI | 1326750621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5759) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070027626) |
| 225100000X Physical Therapist (Licence: CA 304498) | |
| 225100000X Physical Therapist (Licence: KS 11-07417) | |
| 225100000X Physical Therapist (Licence: NY 050838) | |
| 225100000X Physical Therapist (Licence: PA PT031145) | |
| 225100000X Physical Therapist (Licence: NC P20126) | |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2026-10-01 |