| NPI | 1346909561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD CP057844T) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT301812) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NC P22127) | |
| 225100000X Physical Therapist (Licence: VA CP024167T) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2026-06-04 |