| NPI | 1417848250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP053326T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX CP049849T) |
| 225100000X Physical Therapist (Licence: OR CP056069T) | |
| 225100000X Physical Therapist (Licence: SC CP046535T) | |
| 225100000X Physical Therapist (Licence: CO PTL20617) | |
| Enumeration Date | 2025-07-10 |
| Last Update Date | 2026-05-27 |