| NPI | 1669721437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16184) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1260116) |
| 225100000X Physical Therapist (Licence: FL PT27552) | |
| 225100000X Physical Therapist (Licence: CO PTL0013354) | |
| 225100000X Physical Therapist (Licence: IN 05015387A) | |
| 225100000X Physical Therapist (Licence: GA CP026863T) | |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2025-02-12 |