| NPI | 1104295872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 293208) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501017360) |
| 225100000X Physical Therapist (Licence: IN 05012399a) | |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2023-09-02 |