| NPI | 1881915635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC PT6212) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020753) |
| 225100000X Physical Therapist (Licence: NM PT-2024-0150) | |
| 225100000X Physical Therapist (Licence: NY 052383) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2024-07-30 |