| NPI | 1932549284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3877) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002997) |
| 225100000X Physical Therapist (Licence: CA 41462) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2021-04-20 |