| NPI | 1457863805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21979) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32969) |
| 225100000X Physical Therapist (Licence: GA CP028217T) | |
| 225100000X Physical Therapist (Licence: SC 11732) | |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2024-12-31 |