| NPI | 1184018574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14963) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: NC P14963) |
| 2251N0400X Physical Therapist, Neurology (Licence: PA PT023534) | |
| 2251N0400X Physical Therapist, Neurology (Licence: NY 037530) | |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2024-02-20 |