| NPI | 1386602308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT007112L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-012079) |
| 225100000X Physical Therapist (Licence: CA 18374) | |
| 225100000X Physical Therapist (Licence: ID RPT-1130) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2022-11-14 |