| NPI | 1154094860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 10983R) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: MD CP032046T) |
| 2251N0400X Physical Therapist, Neurology (Licence: DC PT210002158) | |
| 2251N0400X Physical Therapist, Neurology (Licence: VA CP025955T) | |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2024-07-05 |