| NPI | 1659731206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT296674) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-3953) |
| 225100000X Physical Therapist (Licence: AZ 11681) | |
| 225100000X Physical Therapist (Licence: OR 61452) | |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2021-03-23 |