| NPI | 1851807127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24659) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 65310) |
| 225100000X Physical Therapist (Licence: SD 6132) | |
| 225100000X Physical Therapist (Licence: MI 5501021622) | |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2026-02-27 |