| NPI | 1750377248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 86PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 105054-2401) |
| 225100000X Physical Therapist (Licence: CA 9141) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2023-05-10 |