| NPI | 1881056620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024977) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 12088) |
| 225100000X Physical Therapist (Licence: HI PT-4421) | |
| 225100000X Physical Therapist (Licence: WA PT.60822884) | |
| 225100000X Physical Therapist (Licence: OR 62356) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-07-05 |