| NPI | 1215114590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6859) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 38606) |
| 225100000X Physical Therapist (Licence: WA PT60121015) | |
| 225100000X Physical Therapist (Licence: AZ 8269PT) | |
| 225100000X Physical Therapist (Licence: IL 070016392) | |
| 225100000X Physical Therapist (Licence: NC P11211) | |
| 225100000X Physical Therapist (Licence: VA 2305205273) | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2021-03-12 |