| NPI | 1053826024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63693) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4645) |
| 225100000X Physical Therapist (Licence: AZ 11993) | |
| 225100000X Physical Therapist (Licence: CA 43486) | |
| 225100000X Physical Therapist (Licence: WA CP012029T) | |
| 225100000X Physical Therapist (Licence: OH PT015341) | |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2022-07-13 |