| NPI | 1346592573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1217970) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 300868) |
| 225100000X Physical Therapist (Licence: FL PT37235) | |
| 225100000X Physical Therapist (Licence: IL 070.025932) | |
| 225100000X Physical Therapist (Licence: NY 047341) | |
| 225100000X Physical Therapist (Licence: SD 2356) | |
| 225100000X Physical Therapist (Licence: CT 13316) | |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2022-03-22 |