| NPI | 1659459147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC 871716) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038547) |
| 225100000X Physical Therapist (Licence: MD 25776) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305208854) | |
| 111N00000X Chiropractor (Licence: CA DC27448) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-03-21 |