| NPI | 1144459157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 291781) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3696) |
| 225100000X Physical Therapist (Licence: TX 1196038) | |
| 225100000X Physical Therapist (Licence: FL 29089) | |
| 225100000X Physical Therapist (Licence: IL 070.017161) | |
| 225100000X Physical Therapist (Licence: IA 004432) | |
| Enumeration Date | 2009-07-11 |
| Last Update Date | 2017-03-29 |