| NPI | 1831565050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024618) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PT0017090) |
| 225100000X Physical Therapist (Licence: WA PT61065014) | |
| 225100000X Physical Therapist (Licence: ID PT-8783) | |
| 225100000X Physical Therapist (Licence: CA 296079) | |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2026-04-27 |