| NPI | 1124279278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7270) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10611) |
| 225100000X Physical Therapist (Licence: CA 25130) | |
| 225100000X Physical Therapist (Licence: FL 24319) | |
| 225100000X Physical Therapist (Licence: CO 10609) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2023-08-02 |