| NPI | 1720695679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 22165) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64554) |
| 225100000X Physical Therapist (Licence: NY 046291) | |
| 225100000X Physical Therapist (Licence: AZ 32708) | |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2024-01-16 |