| NPI | 1578041141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 042082) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294344) |
| 225100000X Physical Therapist (Licence: WA PT60870417) | |
| 225100000X Physical Therapist (Licence: VA 2305211574) | |
| 225100000X Physical Therapist (Licence: SC 8784) | |
| 225100000X Physical Therapist (Licence: NC P17676) | |
| Enumeration Date | 2018-08-05 |
| Last Update Date | 2021-04-09 |