| NPI | 1952687584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2642) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1658) |
| 225100000X Physical Therapist (Licence: WA PT60235492) | |
| 225100000X Physical Therapist (Licence: UT 8217793-2401) | |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2022-08-12 |