| NPI | 1245704485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24187) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 300291) |
| 225100000X Physical Therapist (Licence: MD 27508) | |
| 225100000X Physical Therapist (Licence: VA 2305212679) | |
| 225100000X Physical Therapist (Licence: WV PT004064) | |
| 225100000X Physical Therapist (Licence: ME PT5336) | |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2024-02-13 |