| NPI | 1518479377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038974) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294243) |
| 225100000X Physical Therapist (Licence: TX 1269171) | |
| 225100000X Physical Therapist (Licence: WA PT60761942) | |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2024-11-08 |