| NPI | 1851832588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 292860) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4869) |
| 225100000X Physical Therapist (Licence: OH 016573) | |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |