| NPI | 1396493540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20971) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11934) |
| 225100000X Physical Therapist (Licence: AK 213937) | |
| 225100000X Physical Therapist (Licence: CA 301992) | |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2025-05-12 |