| NPI | 1366403933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 27310) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2315) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-09-17 |