| NPI | 1134178825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 3504) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 21066) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2022-07-21 |