| NPI | 1902393416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 294299) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT6323) |
| 225100000X Physical Therapist (Licence: NC P17330) | |
| 225100000X Physical Therapist (Licence: SC 8747) | |
| 225100000X Physical Therapist (Licence: VA 2305211393) | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2018-04-19 |