| NPI | 1154600898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT3977) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT40710) |
| 225100000X Physical Therapist (Licence: MO 2007036353) | |
| 225100000X Physical Therapist (Licence: ID PT2738) | |
| 225100000X Physical Therapist (Licence: OR 6327) | |
| 225100000X Physical Therapist (Licence: NM 4014) | |
| 225100000X Physical Therapist (Licence: WA PT60192755) | |
| 225100000X Physical Therapist (Licence: MA 20012) | |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2017-08-05 |