| NPI | 1902416241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 295213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1307269) |
| 225100000X Physical Therapist (Licence: HI PT-4929) | |
| 225100000X Physical Therapist (Licence: TN 13012) | |
| Enumeration Date | 2020-08-02 |
| Last Update Date | 2020-08-02 |