| NPI | 1013486075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043920-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36614) |
| 225100000X Physical Therapist (Licence: CA PT301066) | |
| 225100000X Physical Therapist (Licence: MI 5501021672) | |
| 225100000X Physical Therapist (Licence: CT 013170) | |
| 225100000X Physical Therapist (Licence: MA 25923) | |
| 225100000X Physical Therapist (Licence: SC 10799) | |
| 225100000X Physical Therapist (Licence: PA PT030119) | |
| 225100000X Physical Therapist (Licence: NJ 40QA02065700) | |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2022-03-02 |