| NPI | 1790598514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 13300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61655964) |
| 225100000X Physical Therapist (Licence: WY PT2584) | |
| 225100000X Physical Therapist (Licence: MI 5501303772) | |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2026-03-17 |