| NPI | 1164859401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40257) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208018) |
| 225100000X Physical Therapist (Licence: NC P14301) | |
| 225100000X Physical Therapist (Licence: SC 7046) | |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2013-10-01 |