| NPI | 1760891006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3287) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA 13231) |
| 225X00000X Occupational Therapist (Licence: NV 15-0575) | |
| 225100000X Physical Therapist (Licence: CA 43473) | |
| 225100000X Physical Therapist (Licence: TX 1258687) | |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2016-04-26 |