| NPI | 1457966293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 66044) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 4384) |
| 225100000X Physical Therapist (Licence: AZ LPT-034484) | |
| 225100000X Physical Therapist (Licence: NV 4384) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0019677) | |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2026-04-02 |