| NPI | 1801145263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 10984) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20218) |
| 225100000X Physical Therapist (Licence: AK 2944) | |
| 225100000X Physical Therapist (Licence: CO PTL.0012751) | |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2015-11-18 |