| NPI | 1508464199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 19742) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213896) |
| 225100000X Physical Therapist (Licence: WA PT61328519) | |
| 225100000X Physical Therapist (Licence: OR 63965) | |
| 225100000X Physical Therapist (Licence: AL PTH10027) | |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2024-10-30 |