| NPI | 1386151181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT301950) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4663) |
| 225100000X Physical Therapist (Licence: TX 1283393) | |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2024-06-21 |