| NPI | 1336384668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1196551) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.016342) |
| 225100000X Physical Therapist (Licence: MO 2009013293) | |
| 225100000X Physical Therapist (Licence: PA PT019692) | |
| 225100000X Physical Therapist (Licence: NE 2768) | |
| 225100000X Physical Therapist (Licence: MD 22782) | |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2022-01-29 |