| NPI | 1174068720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1345001) |
| 2251G0304X Physical Therapist, Geriatrics | |
| 2251H1300X Physical Therapist, Human Factors | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: NY 036856) | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2021-07-06 |