| NPI | 1043669401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY CP017183T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT012409) |
| 225100000X Physical Therapist (Licence: TX 1359583) | |
| 225100000X Physical Therapist (Licence: KS 11-07119) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2022-12-21 |