| NPI | 1861817801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 13484) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT012203) |
| 225100000X Physical Therapist (Licence: TX 1254338) | |
| 225100000X Physical Therapist (Licence: MD 24972) | |
| 225100000X Physical Therapist (Licence: SC 7282) | |
| 225100000X Physical Therapist (Licence: NC P13484) | |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2022-01-17 |