| NPI | 1396230918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 305298) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 61217784) |
| 225100000X Physical Therapist (Licence: MI 5501020247) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2024-08-27 |