| NPI | 1588200323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61290039) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01935900) |
| 225100000X Physical Therapist (Licence: NY 045270) | |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2023-04-19 |