| NPI | 1356701916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16165) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006733) |
| 225100000X Physical Therapist (Licence: OR 63222) | |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2026-04-17 |