| NPI | 1043485592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 34646) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048421) |
| 225100000X Physical Therapist (Licence: OH PT 012068) | |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2024-10-07 |