| NPI | 1447711635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296826) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS 6493) |
| 225100000X Physical Therapist (Licence: WA 60933223) | |
| 225100000X Physical Therapist (Licence: UT 10824901-2401) | |
| 225100000X Physical Therapist (Licence: OR 63030) | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2023-09-07 |