| NPI | 1871804831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC 872263) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070020379) |
| 225100000X Physical Therapist (Licence: MD 27055) | |
| 225100000X Physical Therapist (Licence: VA 2305213700) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2020-10-19 |