| NPI | 1093130650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11801) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AZ 2989) |
| 225100000X Physical Therapist (Licence: MD 24895) | |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2022-08-25 |