| NPI | 1649565474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT021286) |
| 225100000X Physical Therapist (Licence: VA 2305208435) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2020-03-28 |