| NPI | 1891276002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41242) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 295368) |
| 225100000X Physical Therapist (Licence: WI 16979024) | |
| 225100000X Physical Therapist (Licence: MI 5501303458) | |
| 225100000X Physical Therapist (Licence: PA PT031989) | |
| 225100000X Physical Therapist (Licence: NY 051858-01) | |
| 225100000X Physical Therapist (Licence: OH PT020997) | |
| 225100000X Physical Therapist (Licence: IL 70028022) | |
| 225100000X Physical Therapist (Licence: GA PT017254) | |
| 225100000X Physical Therapist (Licence: TX 1388273) | |
| 225100000X Physical Therapist (Licence: MA PT27484) | |
| Enumeration Date | 2018-08-25 |
| Last Update Date | 2025-06-02 |