| NPI | 1285125211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-14931) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 13264) |
| 225100000X Physical Therapist (Licence: CO PTL.0015447) | |
| 225100000X Physical Therapist (Licence: OR 62403) | |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2018-05-25 |