| NPI | 1356011068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12949) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: AZ LPT-33003) | |
| 225100000X Physical Therapist (Licence: WA PT61640558) | |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2025-09-12 |