| NPI | 1265999205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23501) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT40899) |
| 225100000X Physical Therapist (Licence: AZ LPT-32125) | |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2024-12-30 |