| NPI | 1417486929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-5386) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039745) |
| 225100000X Physical Therapist (Licence: MA 22111) | |
| 225100000X Physical Therapist (Licence: NM PT5570) | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-11-18 |