| NPI | 1144763806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212563) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292535) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2019-01-30 |