| NPI | 1740555994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 4234) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 29786) |
| 225100000X Physical Therapist (Licence: WA 9196) | |
| 225100000X Physical Therapist (Licence: ID 1891) | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2012-03-20 |