| NPI | 1053850610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4053) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27229) |
| 225100000X Physical Therapist (Licence: NC 17876) | |
| 225100000X Physical Therapist (Licence: TN 11544) | |
| 225100000X Physical Therapist (Licence: VA 2305212001) | |
| 225100000X Physical Therapist (Licence: WA 60697660) | |
| 225100000X Physical Therapist (Licence: TX 1281955) | |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2021-10-18 |