| NPI | 1699542696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP057797T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 008957) |
| 225100000X Physical Therapist (Licence: TX CP038562T) | |
| 225100000X Physical Therapist (Licence: CO 20676) | |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2026-05-21 |