| NPI | 1871378372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033822) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 5211) |
| 225100000X Physical Therapist (Licence: CO PTL-0019576) | |
| 225100000X Physical Therapist (Licence: MA S91188777) | |
| 225100000X Physical Therapist (Licence: OR 65296) | |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2024-10-25 |