| NPI | 1083268551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2270) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR CP000249T) |
| 225100000X Physical Therapist (Licence: IA CP000248T) | |
| 225100000X Physical Therapist (Licence: MN 11583) | |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2019-08-01 |