| NPI | 1851343073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 1892) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 11633) |
| 225100000X Physical Therapist (Licence: CA 25855) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2017-12-11 |