| NPI | 1013356005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 42292) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022729) |
| 225100000X Physical Therapist (Licence: OH PT.014211) | |
| Enumeration Date | 2013-06-23 |
| Last Update Date | 2024-02-12 |