| NPI | 1407124910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 8030412-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9307) |
| 225100000X Physical Therapist (Licence: CA 38312) | |
| 225100000X Physical Therapist (Licence: OR 06226) | |
| 225100000X Physical Therapist (Licence: MA 19237) | |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2023-05-09 |