| NPI | 1649726381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1279202) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT44316) |
| 225100000X Physical Therapist (Licence: NY 052168) | |
| 225100000X Physical Therapist (Licence: GA CP050863T) | |
| 225100000X Physical Therapist (Licence: IL 070028096) | |
| 225100000X Physical Therapist (Licence: SC CP052592T) | |
| 225100000X Physical Therapist (Licence: NC CP052591T) | |
| 225100000X Physical Therapist (Licence: WI CP052660T) | |
| 225100000X Physical Therapist (Licence: CA 306236) | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2026-02-05 |