| NPI | 1326929472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 21432) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P24593) |
| 225100000X Physical Therapist (Licence: TN 16835) | |
| 225100000X Physical Therapist (Licence: NY 055013-01) | |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2026-08-03 |