| NPI | 1770061483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295090) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1284722) |
| 225100000X Physical Therapist (Licence: VA 2305206998) | |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2018-08-03 |