| NPI | 1972116473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP042332T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5932) |
| 225100000X Physical Therapist (Licence: GA PT014770) | |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2025-03-11 |