| NPI | 1528614781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD CP011725T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-32055) |
| 225100000X Physical Therapist (Licence: DC PT210002132) | |
| 225100000X Physical Therapist (Licence: IN 05014613A) | |
| 225100000X Physical Therapist (Licence: OH PT018257) | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2023-01-02 |