| NPI | 1972226694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24190) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA LPT034048) |
| 225100000X Physical Therapist (Licence: WA PT61531639) | |
| 225100000X Physical Therapist (Licence: CA 307034) | |
| 225100000X Physical Therapist (Licence: AZ LPT034048) | |
| 225100000X Physical Therapist (Licence: SC 11548) | |
| 225100000X Physical Therapist (Licence: NY 049214) | |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2026-06-24 |