| NPI | 1164825295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 42679) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11198) |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2018-06-14 |