| NPI | 1467864264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20440) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO PTA.0013336) |
| 225200000X Physical Therapy Assistant (Licence: NM A-0852) | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2024-05-26 |