| NPI | 1255470829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 37726) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 2663) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2021-12-30 |