| NPI | 1639886393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP042787T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP039049T) |
| 225100000X Physical Therapist (Licence: CO PTL.0018893) | |
| 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-30101) | |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2025-03-26 |