| NPI | 1770759318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06002855A) |
| 225200000X Physical Therapy Assistant (Licence: AZ 6415A) | |
| 225200000X Physical Therapy Assistant (Licence: TX 2054760) | |
| 225200000X Physical Therapy Assistant (Licence: NC 2271) | |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2019-02-22 |