| NPI | 1548006414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK CP060152T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2026030734) |
| 225100000X Physical Therapist (Licence: AZ LPT-033632) | |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2026-07-30 |