| NPI | 1699351981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT018492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP042634T) |
| 225100000X Physical Therapist (Licence: CO CP048693T) | |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2025-08-18 |