| NPI | 1528001690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4396) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 6252) |
| 225100000X Physical Therapist (Licence: UT 3292592401) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-12-30 |