| NPI | 1497534077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016656) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP044018T) |
| 225100000X Physical Therapist (Licence: TN CP044019T) | |
| 225100000X Physical Therapist (Licence: NC CP044020T) | |
| 225100000X Physical Therapist (Licence: SC CP044021T) | |
| 225100000X Physical Therapist (Licence: KY CP044221T) | |
| 225100000X Physical Therapist (Licence: WI CP044515T) | |
| 225100000X Physical Therapist (Licence: MO CP044614T) | |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2025-05-28 |