| NPI | 1528375490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP026094T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 1160924) |
| 225100000X Physical Therapist (Licence: NC P19947) | |
| 225100000X Physical Therapist (Licence: MA 25769) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2023-11-28 |