| NPI | 1962988485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 294731) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60842320) |
| 225100000X Physical Therapist (Licence: WV 003895) | |
| 225100000X Physical Therapist (Licence: TX 1300718) | |
| 225100000X Physical Therapist (Licence: KY 007332) | |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2018-07-17 |