| NPI | 1336484062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030337) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60314774) |
| 225100000X Physical Therapist (Licence: NY 038924) | |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2022-05-05 |