| NPI | 1881061158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 42916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025633) |
| 225100000X Physical Therapist (Licence: DE J1-0003633) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2020-08-14 |