| NPI | 1083291660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018567) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28681) |
| 225100000X Physical Therapist (Licence: VT 040.0134259) | |
| 225100000X Physical Therapist (Licence: WI 15370) | |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2022-12-23 |