| NPI | 1811242365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292545) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60669915) |
| 225100000X Physical Therapist (Licence: MA 20067) | |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2019-08-27 |