| NPI | 1376308908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 307572) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16648-024) |
| 225100000X Physical Therapist (Licence: MA PTL27686) | |
| 225100000X Physical Therapist (Licence: TN CP029386T) | |
| 225100000X Physical Therapist (Licence: HI PT-6008) | |
| 225100000X Physical Therapist (Licence: AZ CP034963T) | |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2025-03-13 |