| NPI | 1417676180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP041081T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 18645) |
| 225100000X Physical Therapist (Licence: WA PT61627997) | |
| 225100000X Physical Therapist (Licence: OH PT021321) | |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2025-02-20 |