| NPI | 1104597962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT021378) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1383821) |
| 225100000X Physical Therapist (Licence: NY 047694) | |
| 225100000X Physical Therapist (Licence: GA PT015996) | |
| 225100000X Physical Therapist (Licence: CO PTL.0018656) | |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2024-11-20 |