| NPI | 1063894665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT4301) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42383) |
| 225100000X Physical Therapist (Licence: HI 4301) | |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2017-02-08 |