| NPI | 1003331455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT293376) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT30825) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2019-08-23 |