| NPI | 1801365804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211936) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-31888) |
| 225100000X Physical Therapist (Licence: MT 17284) | |
| 225100000X Physical Therapist (Licence: AK 192560) | |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2022-04-19 |