| NPI | 1619358439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25503) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03402) |
| 225100000X Physical Therapist (Licence: ME PT5966) | |
| 225100000X Physical Therapist (Licence: CT 13136) | |
| 225100000X Physical Therapist (Licence: MA 25535) | |
| 225100000X Physical Therapist (Licence: NY 047378) | |
| 225100000X Physical Therapist (Licence: DE J1-0014396) | |
| 225100000X Physical Therapist (Licence: NJ 40QA02019100) | |
| 225100000X Physical Therapist (Licence: MI 5501301792) | |
| 225100000X Physical Therapist (Licence: DC PT200001236) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2022-03-03 |