| NPI | 1164730263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-012319) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-1197) |
| 225100000X Physical Therapist (Licence: NM PT-3364) | |
| 225100000X Physical Therapist (Licence: MT PT-1905) | |
| 225100000X Physical Therapist (Licence: SD PT-1449) | |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2020-10-12 |