| NPI | 1336009836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP056203T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT022122) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN 16878) | |
| Enumeration Date | 2025-11-17 |
| Last Update Date | 2026-05-29 |