| NPI | 1942792577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-31067) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 011443) |
| 225200000X Physical Therapy Assistant (Licence: WV 001995) | |
| 225200000X Physical Therapy Assistant (Licence: OH 09818) | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2021-05-10 |