| NPI | 1114564473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5464) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 051718) |
| 225100000X Physical Therapist (Licence: IL 070027969) | |
| 225100000X Physical Therapist (Licence: PA PT031889) | |
| 225100000X Physical Therapist (Licence: CA 305390) | |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2024-06-27 |