| NPI | 1609277185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7527) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-020833) |
| 225100000X Physical Therapist (Licence: TX 1250079) | |
| 225100000X Physical Therapist (Licence: WA 60525566) | |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2016-08-12 |