| NPI | 1699403097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 31001) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 19921) |
| 225100000X Physical Therapist (Licence: VA 2305216987) | |
| 225100000X Physical Therapist (Licence: NY 048967) | |
| 225100000X Physical Therapist (Licence: NC P23048) | |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2026-08-19 |