| NPI | 1760911846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2015040158) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3248) |
| 225100000X Physical Therapist (Licence: CA 295665) | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2019-02-20 |