| NPI | 1467232819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65541) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 40590) |
| 225100000X Physical Therapist (Licence: ND 2762) | |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2025-04-07 |