| NPI | 1972026607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62114) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 43985) |
| 225100000X Physical Therapist (Licence: CA 293069) | |
| 225100000X Physical Therapist (Licence: CO CP008372T) | |
| 225100000X Physical Therapist (Licence: UT CP008371T) | |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2021-10-19 |