| NPI | 1376247155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0020955) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12959) |
| 225100000X Physical Therapist (Licence: MA 88982) | |
| 225100000X Physical Therapist (Licence: FL PT40056) | |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2026-01-21 |