| NPI | 1164933461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 12897) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 087901) |
| 225100000X Physical Therapist (Licence: CA 294542) | |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2022-03-11 |