| NPI | 1508207069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305208371) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01480600) |
| 225100000X Physical Therapist (Licence: DE J1-0003275) | |
| 225100000X Physical Therapist (Licence: MD 24333) | |
| 225100000X Physical Therapist (Licence: NY 035888) | |
| 225100000X Physical Therapist (Licence: PA PT024300) | |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2015-05-18 |