| NPI | 1548733504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 31093) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60895437) |
| 225100000X Physical Therapist (Licence: NY 043139) | |
| Enumeration Date | 2019-01-02 |
| Last Update Date | 2020-03-30 |