| NPI | 1881021764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA CP015867T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011205) |
| 225100000X Physical Therapist (Licence: CO 12389) | |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2023-04-17 |