| NPI | 1932637881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29017) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0016005) |
| 225100000X Physical Therapist (Licence: PA PT026390) | |
| 225100000X Physical Therapist (Licence: CA 298005) | |
| 225100000X Physical Therapist (Licence: MA 23540) | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2022-07-15 |