| NPI | 1164008272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298472) |
| Additional Taxonomies | 2251C2600X Physical Therapist Cardiopulmonary (Licence: CA 298472) |
| 2251G0304X Physical Therapist Geriatrics (Licence: CA 298472) | |
| 2251N0400X Physical Therapist Neurology (Licence: CA 298472) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: CA 298472) | |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2021-12-06 |