| NPI | 1811448632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE CP051977T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA CP052730T) |
| 225100000X Physical Therapist (Licence: MD CP052772T) | |
| 225100000X Physical Therapist (Licence: NC CP051979T) | |
| 225100000X Physical Therapist (Licence: NV CP052865T) | |
| 225100000X Physical Therapist (Licence: WI CP052769T) | |
| 225100000X Physical Therapist (Licence: IN CP051978T) | |
| 225100000X Physical Therapist (Licence: SC 12018) | |
| 225100000X Physical Therapist (Licence: WV CP051983T) | |
| 225100000X Physical Therapist (Licence: PA CP051980T) | |
| 225100000X Physical Therapist (Licence: VA CP051982T) | |
| 225100000X Physical Therapist (Licence: VT CP051981T) | |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2026-03-27 |