| NPI | 1588855845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-7940) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 9700) |
| 225100000X Physical Therapist (Licence: CA 34755) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2015-08-17 |