| NPI | 1538656244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296521) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: WY 1780) | |
| 225100000X Physical Therapist (Licence: CO PTL.0015489) | |
| 225100000X Physical Therapist (Licence: AZ LPT-30335) | |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2020-05-21 |