| NPI | 1164880464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292920) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2994) |
| 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: NV 2994) | |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2022-04-26 |