| NPI | 1235497918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029354) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 13331) |
| 225100000X Physical Therapist (Licence: CA 301264) | |
| 225100000X Physical Therapist (Licence: SC 10798) | |
| 225100000X Physical Therapist (Licence: KS 11-06940) | |
| 225100000X Physical Therapist (Licence: NY 048542) | |
| 225100000X Physical Therapist (Licence: NC P20917) | |
| 225100000X Physical Therapist (Licence: VT 040.0134367) | |
| 225100000X Physical Therapist (Licence: CO 11080) | |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2022-03-15 |