| NPI | 1427424753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030690) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TEI004005) |
| 225200000X Physical Therapy Assistant (Licence: CA 10832) | |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2022-08-26 |