| NPI | 1427555945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501302647) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014363) |
| 225100000X Physical Therapist (Licence: NC P18425) | |
| 225100000X Physical Therapist (Licence: SC PT.9629) | |
| 225100000X Physical Therapist (Licence: VA CP017357T) | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2024-04-16 |