| NPI | 1790264273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015458A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P21810) |
| 225100000X Physical Therapist (Licence: VA 2305215631) | |
| 225100000X Physical Therapist (Licence: MD 27316) | |
| 225100000X Physical Therapist (Licence: PA PT027136) | |
| 225100000X Physical Therapist (Licence: CO PTL.0019238) | |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2024-03-05 |