| NPI | 1336902980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305217845) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT032099) |
| 225100000X Physical Therapist (Licence: CO PTL.0020146) | |
| 225100000X Physical Therapist (Licence: AZ LPT-034031) | |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2026-06-28 |