| NPI | 1487799276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64368) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 21818) |
| 225100000X Physical Therapist (Licence: NC 10719) | |
| 225100000X Physical Therapist (Licence: ME 3033) | |
| 225100000X Physical Therapist (Licence: CA 33509) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2022-07-15 |