| NPI | 1689032971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT871751) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035751) |
| 225100000X Physical Therapist (Licence: MA 20924) | |
| 225100000X Physical Therapist (Licence: MD 25346) | |
| 225100000X Physical Therapist (Licence: VA 2305209125) | |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2016-02-02 |