| NPI | 1790338218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 33035) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 5574) |
| 225100000X Physical Therapist (Licence: CO PTL.0016494) | |
| 225100000X Physical Therapist (Licence: CA 300101) | |
| 225100000X Physical Therapist (Licence: TX 1393520) | |
| 225100000X Physical Therapist (Licence: IL 70.026658) | |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2025-10-24 |