| NPI | 1639258288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT41112) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 2576) |
| 225100000X Physical Therapist (Licence: MI 5501006499) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2019-08-09 |