| NPI | 1013395243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 037296) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023359) |
| 225100000X Physical Therapist (Licence: AZ 10929) | |
| 225100000X Physical Therapist (Licence: NC 15533) | |
| 225100000X Physical Therapist (Licence: CA 296383) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2019-10-14 |