| NPI | 1598549412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP052363T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT-2025-0292) |
| 225100000X Physical Therapist (Licence: OH PT020718) | |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2026-06-30 |