| NPI | 1114559341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 299983) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP008462T) |
| 225100000X Physical Therapist (Licence: MO 2020004450) | |
| 225100000X Physical Therapist (Licence: NC 2020004450) | |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2023-11-22 |