| NPI | 1508356130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT299985) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013485) |
| 225100000X Physical Therapist (Licence: TN 11752) | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2021-12-01 |