| NPI | 1538687587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65559) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 19117) |
| 225100000X Physical Therapist (Licence: PA PT029154) | |
| 225500000X Specialist/Technologist | |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2025-01-15 |