| NPI | 1346733169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296366) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH8914) |
| 225100000X Physical Therapist (Licence: NM PT5394) | |
| 225100000X Physical Therapist (Licence: TX 1305049) | |
| 225100000X Physical Therapist (Licence: AK 135715) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2019-03-15 |