| NPI | 1972850493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 39090) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 6394) |
| 225100000X Physical Therapist (Licence: VT 040.0134729) | |
| 225100000X Physical Therapist (Licence: OH PT020975) | |
| 225100000X Physical Therapist (Licence: IL 070028149) | |
| 225100000X Physical Therapist (Licence: PA PT032113) | |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: TX 1390459) | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2024-04-29 |