| NPI | 1184023236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1244890) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.025922) |
| 225100000X Physical Therapist (Licence: PA PT029569) | |
| 225100000X Physical Therapist (Licence: NY 048345) | |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2022-03-15 |