| NPI | 1306063458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 27416) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-4547) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2022-04-25 |