| NPI | 1487260279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1341289) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT297804) |
| 225100000X Physical Therapist (Licence: CA A) | |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2021-03-25 |