| NPI | 1124377692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 297498) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003692) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2020-05-29 |