| NPI | 1346611456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT291877) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501017428) |
| 225100000X Physical Therapist (Licence: TX 1267366) | |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2020-02-19 |