| NPI | 1023350865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2009024412) |
| 225100000X Physical Therapist (Licence: AL PTH6368) | |
| 225100000X Physical Therapist (Licence: HI 3588) | |
| 225100000X Physical Therapist (Licence: ID PT-3025) | |
| 225100000X Physical Therapist (Licence: WY PT-1455) | |
| 225100000X Physical Therapist (Licence: NM 4147) | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2013-03-19 |