| NPI | 1700438116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0019745) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH CP008751T) |
| 225100000X Physical Therapist (Licence: OH PT017968) | |
| 225100000X Physical Therapist (Licence: CA PT303606) | |
| 225100000X Physical Therapist (Licence: KY 007689) | |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2024-04-01 |