| NPI | 1952070997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61674861) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1383635) |
| 225100000X Physical Therapist (Licence: AZ LPT-033843) | |
| 225100000X Physical Therapist (Licence: MD 28829) | |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2025-04-28 |