| NPI | 1609525120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0134385) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP061273T) |
| 225100000X Physical Therapist (Licence: CA 308112) | |
| 225100000X Physical Therapist (Licence: NH CP046777T) | |
| 225100000X Physical Therapist (Licence: AZ CP058760T) | |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2026-08-18 |