| NPI | 1154871051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296764) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61219480) |
| 225100000X Physical Therapist (Licence: TX 1278848) | |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2023-08-09 |