| NPI | 1912605726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0135033) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014771) |
| 225100000X Physical Therapist (Licence: ID PT-8996) | |
| 225100000X Physical Therapist (Licence: NC P21974) | |
| 225100000X Physical Therapist (Licence: OR 65306) | |
| 225100000X Physical Therapist (Licence: MA PTL26878) | |
| 225100000X Physical Therapist (Licence: ME 7405) | |
| 225100000X Physical Therapist (Licence: CA 306810) | |
| 225100000X Physical Therapist (Licence: CO PTL19189) | |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2026-04-21 |