| NPI | 1114133279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070016822) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038229) |
| 225100000X Physical Therapist (Licence: HI 2570) | |
| 225100000X Physical Therapist (Licence: AZ 7109) | |
| 225100000X Physical Therapist (Licence: MI 5501006783) | |
| 225100000X Physical Therapist (Licence: NV 1994) | |
| 225100000X Physical Therapist (Licence: FL PT22233) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2018-04-16 |