| NPI | 1184007585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62712) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 100355) |
| 225100000X Physical Therapist (Licence: CO 0013276) | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2024-04-16 |