| NPI | 1578915724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3366) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM PT2023-2062) |
| 225100000X Physical Therapist (Licence: AZ 31586) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-03-21 |