| NPI | 1740400258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-002785) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1132173) |
| 225100000X Physical Therapist (Licence: NV 1401) | |
| 225100000X Physical Therapist (Licence: PA PT006917L) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2024-10-29 |