| NPI | 1205170081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19120) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9201) |
| 225100000X Physical Therapist (Licence: TX 1284818) | |
| 225100000X Physical Therapist (Licence: HI 4315) | |
| 225100000X Physical Therapist (Licence: SC 8065) | |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2020-11-09 |