| NPI | 1144744152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29714) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 087613) |
| 225100000X Physical Therapist (Licence: CO PTL.0016232) | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2024-12-21 |