| NPI | 1578035762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT-2025-0169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043740-1) |
| 225100000X Physical Therapist (Licence: WA PT61552035) | |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2025-07-28 |