| NPI | 1467098764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0019514) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 61553416) |
| 225100000X Physical Therapist (Licence: AL 9668) | |
| 225100000X Physical Therapist (Licence: CA 305225) | |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2026-04-13 |