| NPI | 1285181792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002137) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1347405) |
| 225100000X Physical Therapist (Licence: MA PTL22588) | |
| 225100000X Physical Therapist (Licence: CT 11503) | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2024-06-28 |