| NPI | 1356791628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT026606) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT021678) |
| 225100000X Physical Therapist (Licence: MO 2016020586) | |
| 225100000X Physical Therapist (Licence: KY 009303) | |
| 225100000X Physical Therapist (Licence: NM PT-2025-0093) | |
| 225100000X Physical Therapist (Licence: MD 30368) | |
| 225100000X Physical Therapist (Licence: NY 054129) | |
| 225100000X Physical Therapist (Licence: TX 1406689) | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2025-06-11 |