| NPI | 1386013092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC CP050839T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0023092) |
| 225100000X Physical Therapist (Licence: PA PT028944) | |
| 225100000X Physical Therapist (Licence: WA PT70005541) | |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2025-12-04 |