| NPI | 1629389028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 102707) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-02684) |
| 225100000X Physical Therapist (Licence: AZ 3876) | |
| 225100000X Physical Therapist (Licence: CA 22719) | |
| 225100000X Physical Therapist (Licence: FL 20963) | |
| 225100000X Physical Therapist (Licence: NV 1093) | |
| 225100000X Physical Therapist (Licence: TX 1150938) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2010-06-30 |