| NPI | 1801864384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292844) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070013765) |
| 225100000X Physical Therapist (Licence: GA PT010578) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2019-05-31 |