| NPI | 1750813416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 012792) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 35125) |
| 225100000X Physical Therapist (Licence: OH 018191) | |
| 225100000X Physical Therapist (Licence: CA 297506) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2020-02-17 |