| NPI | 1801291562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 3883) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12913 - 24) |
| 225100000X Physical Therapist (Licence: TX 1212447) | |
| 225100000X Physical Therapist (Licence: CA 291303) | |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2018-04-24 |