| NPI | 1710751631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT.PT.61677447) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-034589) |
| 225100000X Physical Therapist (Licence: NJ 40QA02223500) | |
| Enumeration Date | 2023-11-10 |
| Last Update Date | 2026-08-11 |