| NPI | 1972938777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP-CP029548T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 60342) |
| 225100000X Physical Therapist (Licence: TX 1283349) | |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2024-03-25 |