| NPI | 1437633658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4430) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0015815) |
| 225100000X Physical Therapist (Licence: VA 2305212280) | |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2020-03-26 |