| NPI | 1407674252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP049652T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CO039948T) |
| 225100000X Physical Therapist (Licence: OH PT021361) | |
| 225100000X Physical Therapist (Licence: VA CP035163T) | |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2025-09-22 |