| NPI | 1952718454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16088) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208328) |
| 225100000X Physical Therapist (Licence: MD 24722) | |
| 225100000X Physical Therapist (Licence: NY 036429) | |
| 225100000X Physical Therapist (Licence: TX 1238759) | |
| 225100000X Physical Therapist (Licence: OR 60549) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2023-02-14 |