| NPI | 1639995947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42252) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-034835) |
| 225100000X Physical Therapist (Licence: WA PT.PT.70072080) | |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2026-07-20 |